Welfare Reform on the Web (November 2006): Healthcare - Overseas

Beliefs about informal payments in Albania

T. Vian and L.J. Burak

Health Policy and Planning, vol.21, 2006, p.392-401

Informal payments for health care are a growing concern in Albania and other transition states. While some patients make informal payments willingly to express gratitude or expedite care, others feel compelled to make them to secure quality services or even any care at all. Medical personnel in Albanian public health facilities are paid a salary by the government and are forbidden to accept payment from patients. However, informal payments in the Albanian health sector are still common. Many countries are putting in place reforms aimed at reducing informal payments. For these reforms to be successful, they need to consider people’s attitudes and beliefs about the practice. This study collected data from 222 Albanian citizens regarding intentions, past behaviours, attitudes and beliefs about informal payments.

The economics of infectious disease

J. A. Roberts (editor)

Oxford: Oxford University Press, 2006

Infectious diseases represent a growing challenge to public health systems. The world is facing threats from new diseases such as AIDS, MRSA, SARS and Avian Flu, as well as old ones such as tuberculosis. The book presents the contribution economists can make to the management and control of infectious diseases. It provides an economic evaluation of specific diseases and examines the wider issues involved in the economics of infectious diseases: modelling, governance and the control of outbreaks, risk assessment models for food safety, the global perspective and the role of international regulatory co-operation, and the effect on trade.

The effect of substance abuse treatment on Medicaid expenditures among general assistance welfare clients in Washington State

T.M. Wickizer and others

Milbank Quarterly, vol.84, 2006, p.555-576

The sustained increase in Medicaid costs has placed US state budgets under strain. Because states must control expenditure, demonstrating the economic value of publicly financed programmes will become increasingly important in the future. This study evaluated the economic impact of substance abuse treatment on medical expenditures, primarily Medicaid expenses, for general assistance welfare clients in Washington State. It compared substance abusers in the welfare population who received treatment with those who did not and found that treatment was associated with a 35% reduction in annual medical expenses, an amount equal to the cost of treatment. It is concluded that decisions by various states to cut costs by reducing access to substance abuse treatment for people receiving welfare are likely to be counterproductive. In addition, the authors note that substance abuse treatment in this population is associated with reduced criminal activity and higher employment.

Generics markets in Greece: the pharmaceutical industry’s beliefs

M. Geitona and othes

Health Policy, vol.79, 2006, p.35-48

Use of generic drugs is not officially promoted in Greece, and their consumption is small compared to other countries at 9.7% of the market for pharmaceuticals in 2003. However, a survey of Greek drug companies reported in this article shows that they are generally positive about generics. Companies intend to continue operating in this sector, aiming to change the current legal and institutional framework.

“Health courts” and accountability for patient safety

M.M. Mello and others

Milbank Quarterly, vol.84, 2006, p.459-492

This article proposes moving medical malpractice claims in the USA out of the tort system into an alternative administrative system known as a health court. It describes how health courts might work, and their advantages for improving patient safety. These include the development of a “culture of safety and disclosure” that would enhance the ability of medical institutions to address the causes of avoidable harm to patients. To facilitate the creation of such a culture, it is recommended that health courts should be separate from disciplinary procedures.

Estonia has successfully implemented multifaceted primary health care reforms, including new organisational structures, user choice of family physician, new payment methods, specialist training in family medicine, service contracts for family practitioners, broadened scope of services and evidence-based guidelines. Primary health care effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by family practitioners in community settings and reduced hospital admissions. Introduction of these reforms was facilitated by strong leadership, good co-ordination between the policy and operational levels, a practical approach to implementation emphasising simple interventions easily understood by potential adopters, a roll-out strategy which avoided direct confrontation with opponents in the capital, Tallinn, careful change management which avoided health reforms being politicised too early in the process, and early investment in training to create a critical mass of health professionals able to implement the reforms.

Pursuing cost containment in a pluralistic payer environment: from the aftermath of Clinton’s failure at health care reform to the Balanced Budget Act of 1997

R. Mayes and R.E. Hurley

Health Economics, Policy and :Law, vol.1, 2006, p.237-261

During the mid-1990s the introduction of managed care successfully reined in spiralling medical costs in the USA. It addressed, for a time, the two main problems with traditional indemnity health insurance: 1) the “moral hazard” problem, whereby insured persons received excessive medical care because virtually all expenses were reimbursed; and 2) the “demand inducement” problem, whereby physicians and hospitals tended to over-supply medical services for the same reason. The success of managed care, however, was short-lived. In their efforts to control costs and remain profitable, the behaviour of many managed care organisations triggered a populist backlash and widespread disenchantment with the system. Medical providers regained leverage relative to health maintenance organisations and health care cost inflation returned. In 1997 Congress and President Clinton passed the Balanced Budget Act which sought to control health care costs by reining in Medicare expenditure and increasing the number of the programme’s beneficiaries in private health care plans.

Retaining nurses in their employing hospitals and in the profession: effects of job preference, unpaid overtime, importance of earnings and stress

I.U. Zeytinoglu and others

Health Policy, vol.79, 2006, p.57-72

In the context of a shortage of nurses in Canada, this paper examines their job characteristics and the work environment factors that encourage staff retention. Data come from a survey of 1396 nurses employed in three teaching hospitals in Ontario. With regard to retaining nurses in their hospitals, being able to work in their preferred type of job is important, particularly for part-time staff. Being expected to work unpaid overtime is a factor increasing the likelihood of part-time nurses leaving the profession. All nurses are less inclined to leave as the importance of their earnings for the family increases, but this is again particularly relevant for part-time staff. Stress is an ongoing concern, and leads many to leave their hospitals and the profession.